Factors Predicting Postoperative Esophageal Stricture after Repaired Tracheoesophageal Malformation in Children with Esophageal Atresia

Peticha Tanprasert¹, Jiraporn Khorana¹, Kanokkan Tepmalai¹

Affiliation : ¹ Pediatrics Surgery Unit, Department of Surgery, Chiang Mai University, Chiang Mai, Thailand

Background: An esophageal stricture is the most frequent complication after surgical correction for esophageal atresia (EA) patient, resulting in hospitalization or surgical intervention.
Objective: To describe the characteristics of EA with a stricture and assess the factors influencing the postoperative esophageal stricture.
Materials and Methods: All children after surgical correction between 1999 and 2014 were included. All complications at one and five years were recorded and predicting factors for esophageal stricture were analyzed.
Results: Forty-seven patients were recorded. Thirty-one EA patients were divided into two groups as stricture and non-stricture. Stricture had 18 patients and non-stricture had 13 patients. Median follow-up time of EA with esophageal stricture was 10 years (3,690.5 days), and 5.7 years (2082.0 days) for EA without stricture. Vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities (VACTERL) association was found in 38% and 58.1% had anastomotic stricture. The waiting time from birth to surgical repair was significantly longer in the stricture group at 15 versus 3 days (p=0.009). The median esophageal stricture time was about five years (1,829 days). The most common clinical presentation of EA with stricture was dysphagia following with recurrent pneumonia. Respiratory pneumonia was more common in the stricture group (p=0.033).
Conclusion: Primary repairs should not be delayed in EA patients. Anastomotic strictures can be found beyond the fifth year after surgery. A multidisciplinary follow-up plan should be continued for longer than five years to enable the detection of further late stricture formation.

Received 8 November 2021 | Revised 29 November 2022 | Accepted 9 December 2022

Keywords : Esophageal atresia; Tracheoesophageal fistula; Congenital esophageal atresia; Postoperative esophageal stricture

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